Ear problems Q&A with audiologist Karen Finch
Audiologist Karen Finch joined us in November 2012 to answer questions on ear health, including problems ranging from wax build-ups to perforated eardrums.
Karen is managing director of The Hearing Care Centre in Ipswich. She is past president and a current fellow of the British Society of Hearing Aid Audiologists (BSHAA), a member of the British Society of Audiology (BSA) and the Association of Independent Hearing Healthcare Professionals (AIHHP).
Q. Waspie: My son is almost five and has just started reception. His speech was not delayed but he finds some sounds extremely difficult to replicate, particularly J, G, CH, SH and TH. We finally had his hearing tested in the summer and saw a consultant.
The consultant confirmed that his hearing was significantly affected and diagnosed 'glue ear'. He suggested grommets and removal of adenoids. He also said that the problem was likely to rectify itself by the age of six or seven years as the Eustachian tubes grow.
I'm uncomfortable with the idea of putting my son through a procedure for a problem that will resolve itself in time. Is there any other way to help him maintain relatively good hearing, perhaps by helping keep his Eustachian tubes as clear as possible, without the need for surgery?
A. Karen Finch: This is a difficult one to answer without being able to determine the level of hearing loss being affected by the 'glue ear'. If the loss is causing him to struggle in school with the teachers and other pupils, this may well affect his learning ability. So, in this case, you would need to weigh up having the simple and quick surgery against the possibility of being held back.
One way to assist the Eustachian tubes to keep clear is inhaling steam perhaps adding a couple of drops of Olbas Oil. But this can also be quite frightening for a child and unless inhaled deeply of no help to the situation either.
Q. Turkeyboots: 1. Is there a risk of permanent hearing loss from glue ear? My son has had awful glue hear and 'moderate' hearing loss before grommets were put in. They've made a huge difference so far, but still a bit concerned as we approach school starting age.
2. How accurate are baby and toddler hearing tests? They seem more of an art than a science.
A. Karen Finch: 1. Glue ear is common. More than seven in 10 children have at least one episode of glue ear before they are four years old. In most cases, it only lasts a short while. Boys are more commonly affected than girls.
2. There are two screening tests that may be used. Automated Auditory Brainstem Response (AABR). This test measures how the hearing nerve responds to sound. Clicks or tones are played through soft earphones into the baby's ears. Three electrodes placed on the baby's head measure the hearing nerve's response.
Otoacoustic Emissions (OAE). This test measures sound waves produced in the inner ear. A tiny probe is placed just inside the baby's ear canal. It measures the response (echo) when clicks or tones are played into the baby's ears.
Both tests are quick (about five to 10 minutes), painless, and may be done while your baby/child is sleeping or lying still.
Q. Onetwothreeoops: My seven-year-old son has very waxy ears. He also wears hearing aids. The wax works its way into the hearing aid tubes and usually stops them working before the end of the school day.
Our nearest audiologist is nearly an hour away so every time I take him to have the wax removed he misses about three hours of school, which is not ideal. The audiologist will not suggest any way of removing earwax at home. Obviously, putting oil into the ears is no good because the wax has nowhere to go, I've tried ear drops with hydrogen peroxide but this made the skin inside his ears sore.
Are there any other options for removing wax at home? I am willing to be trained to use an ear shower machine but I'm not sure if that is an option.
A. Karen Finch: Earwax should only ever be removed by a trained professional.
Earwax production can be stimulated by excessive ear clearance as quite simply the ear needs earwax to maintain a healthy ph balance and to ward off bacteria and bugs. It's your very own antiseptic sitting right in the ear canal itself. So every time the ear is stripped of this natural substance it may just reproduce itself very quickly replacing and restoring the acid/alkaline levels.
Using a regular dose of olive oil ear drops (such as Cerumol) has proven to be successful with slowing down the wax gland production, meaning that less frequent earwax removal is required and over time this may well be able to be controlled just by the drops alone.
Q. Scarahscreams: Are waxy ears linked to diet?
A. Karen Finch: There are some studies that show that earwax production can be attributed to higher levels of cholesterol (fatty diet) eg (Roeser & Ballachandar, 1997).
Q. Purplywurply: My three-year-old child's earwax is always very dark brown, is this normal?
A. Karen Finch: Yes, it's normal, in fact when earwax is secreted from the wax glands it has the consistency of water and is clear but it soon oxidizes and changes through a colour process of pale yellow – orange, tan, dark brown and black the longer it stays in the ear. To assist the migration of earwax that isn't departing the ear easily use some olive oil ear drops (such as Cerumol) to soften the wax.
Q. Lucyj33: My daughter has had significant hard wax build-up in her ears. It was noticed by the GP when she was poorly with something else. We treated them with oil four times a day and when softened the wax was 'hoovered' out.
How can I tell if the wax is building up again? Is there a gadget I can use to check her ears?
A. Karen Finch: An otoscope is the instrument used by a trained clinician to enter the entrance of the ear canal to view the health of the ear canal and ear drum. But I do not advocate any untrained individual to view another's ears, as entering the ear canal always carries a risk.
You are taking the best maintenance routine that current studies show may be helpful by using olive oil drops routinely.
Q. Kveta: My daughter (nearly five months) has very waxy ears, and is constantly clawing at them, so has a wound in each ear which she scratches open every time they look like healing. The GP told me there is no sign of infection, but she stops scratching if given Calpol. Is there any other way to alleviate the itching?
A. Karen Finch: Itchy ear syndrome is normally caused by a dry eczema-like surface to the ear canal and yet you describe excess earwax which would suggest that the ear is moist and sticky. Although there are two types of ear wax, both wet and dry.
It can be a bit of a cycle as when the surface of the ear is lacerated by an abrasive object eg pen, hairgrip and in this case a fingernail, it will secrete a fluid to seal the wound in the same way as if you made a cut to the surface of the skin elsewhere in the body.
This fluid will dry causing a crust, which in turn the healing process will irritate and relief is sought by further scratching. So the rules to abide by whilst the cycle is in progress: keep the ears dry, keep hands and all other implements out, lubricate the ear with something like Cerumol Olive Oil Ear Drops to keep the skin soft and less inclined to itch, and gently press the ear from behind the bottom of the lobe when the itch occurs to alleviate.
Q. SkiBumMum: My daughter had grommets six weeks ago. The consultant says it's fine to get her ears wet again, but everything I read suggests the opposite. Who is correct?
A. Karen Finch: This isn't the advice I would generally give to a parent whose child had recently undergone a grommet procedure. My reason for this is that water may contain some bacteria which could get into the ear and get trapped, this in turn could then grow in the warm environment causing ear infections. Just to play safe, use an ear plug of some sort to avoid water entering the ear canal.
Q. Ripsishere: My daughter had grommets three years ago. Both are out now, one had settled into a ball of wax at the bottom of her ear and she had it syringed out. My husband is a scuba diver and would like to take her for a training session in March. Would this be safe?
A. Karen Finch: The risk of pressure on the eardrums when scuba diving is much higher and therefore perhaps a concern to those that have undergone any ear surgery. In your daughter's case, I would have your GP/ENT just check that the eardrums have completely healed before embarking on such an activity.
Q. DeWe: My son had grommets at 20 months after continuous infections since three months. He had grommets again at three years old, after suffering eight perforated eardrums in three months. The grommets are now out again (age five) and he gets occasional mild ear pain, but no infections. I have two questions.
- If he's not getting infections, but still has glue ear, would you recommend more grommets (his behaviour is poor when he can't hear), or would hearing aids be a better option? Because I'm wondering how damaged his eardrum is already.
- Since the grommets came out last March, he's had four bouts of tonsilitis (having never had it before) where he appears very ill. Is this related to the ear infections, or a separate issue?
A. Karen Finch: 1. This is debatable! Some medics would say that as the continuous ear infections appear to have ceased it would appear that the Eustachian tube is growing and the ears' ability to equalise is improving. Any operation carries risk and also adds scarring to the eardrum for the future. Others would say put another set of grommets in place to reduce the chances of any future ear infections.
2. Tonsillitis is inflammation due to infection of the tonsils. It is a very common condition, most frequent in children aged five to 10 years and young adults between 15 and 25 years. It appears to affect those with a lower immune system and although all within the 'Ear, Nose & Throat' area, it is not directly linked to the grommets procedure.
Q. Aristocat: A while ago my son had to go to hospital to have wax build-up removed. We were told he might have perforated his eardrum, but that was not the case. Is it correct that as he grows his Eustachian tube will straighten out and we may not have this problem again? He is 10 years old now.
A. Karen Finch: It is true that the Eustachian tube will straighten as your son gets older, but the wax production isn't linked to this area of the auditory system. The ET's main purpose is to provide equalisation of the pressure from outside to inside.
The Eustachian tube also drains mucus from the middle ear. Upper respiratory tract infections (eg common cold virus) or allergies can cause the Eustachian tube, or the membranes surrounding its opening to become swollen, trapping fluid, which serves as a growth medium for bacteria, causing ear infections. It's the ear infection that may cause the perforating of the eardrum itself.
To assist the safe migration of a wax build up, I suggest the twice-weekly use of 1-2 drops of Cerumol Olive Oil Ear Drops, a natural way to gently soften and remove earwax, which has no known side-effects.
But last and not least NO cotton buds! The average ear canal length in an adult is 28mm long; a cotton bud averages 13mm, so putting this implement into the ear increases the danger of perforating the eardrum and also pushing wax from the entrance of the ear back down the canal, impacting it further. As you can imagine, a child's ear length is shorter but the cotton bud stays the same length, introducing a far higher and unnecessary risk.
Q. WowOoo: I'd like to know if I should clean my son's ears with cotton buds. I was told that the outside part is OK, just not inside. If I can't do this, how do I get rid of the horrible wax I can sometimes see?
A. Karen Finch: See the answer to Aristocat above. Cleaning the outer ear is just as effective using a flannel clearing the soft wax which is sited right at the very entrance to the ear. But any deeper and that's a no, no.
Q. SHRIIIEEEKPoolingBearBlood: Is there any link between breastfeeding and ear infections? My son suffered badly from infections from 18 months and I was told not to let him eat or drink lying down.
A. Karen Finch: I am unaware of any studies linking breastfeeding and ear infections.
In children, the Eustachian tubes are narrow and are very pliable; they are also at an angle that makes them more likely to malfunction. Together, these three childhood attributes are the main reason that very young children, especially those younger than age five, get frequent ear infections. In most cases, the Eustachian tubes become fully functional and normalised by adulthood.
Q. HufftheHedgehog: My son is five and each winter gets ear infections (usually after a cold), which quite often result in him being given antibiotics. Is this something that he is likely to grow out of?
He saw a consultant last year as I was concerned about his hearing. The consultant diagnosed glue ear and said that it was something that gets worse in the winter, and improves again over the summer. Is there anything I can do during the winter months to stop the glue ear getting worse?
A. Karen Finch: Yes, it is highly likely that your son will grow out of the common childhood ear infections. In children, the Eustachian tubes are narrow and are very pliable; they are also at an angle that makes them more likely to malfunction. The Eustachian tube drains mucus from the middle ear. Upper respiratory tract infections, eg the dreaded and most common cold virus, can cause the Eustachian tube, or the membranes surrounding its opening to become swollen, trapping fluid, which serves as a growth medium for bacteria, causing ear infections.
Your consultant's statement really refers to the fact there are more cold viruses around in the winter months.
Q. JugglingwithPossibliities: When my daughter was little she used to occasionally get horrible ear ache when she had a cold. I tried to give her some Calpol but she wasn't always amenable to having it. What else could I have done to help?
A. Karen Finch: In fact you could have done very little more. If the eardrum is under pressure due to a cold it will cause a change of pressure, which in turn causes an ache. The body will try to fight the possible invasion of bacteria and whilst all this is going on, the body's temperature may rise etc. So, using some kind of child pain relief according to the manufacturer's instructions may assist. But in the main just some TLC and watch and wait!
Q. Oricella: After years of infections every other month or so, my four year old now seems to have permanent perforations in both eardrums. Nevertheless, until now her hearing seems to be fine, when last tested it was within the normal range, and she has been infection-free for five months. In your experience, how common are permanent perforations? Is there a chance they will heal over time?
A. Karen Finch: Most perforations of the eardrum repair themselves in one way or another. The skin that forms naturally to repair the break will differ slightly to that of the original eardrum causing scarring and is easily identifiable to the clinical trained eye. Massive perforations will need an ENT surgeon to carry out a tympanoplasty (skin graft) of the eardrum.
Q. SchmaltzingMatilda: My question is the same as HufftheHedgehog's about winter colds leading to infection and glue ear. The audiologist at the hospital said to treat with antibiotics ASAP to protect the eardrum, reduce pain, recover hearing. However, my GP practice is very reluctant to prescribe antibiotics unless my daughter has been suffering from hearing loss and pain for a number of weeks.
Who is right about the correct approach and what else can I be doing for her?
A. Karen Finch: Routine prescribing of antibiotics always carries a risk and therefore GPs are responding to evidence-based practice outcomes that show that many earaches will diminish before any antibiotics would even kick in.
In the cases of those suffering with earache/infections for more than three to four days, I would suggest that a visit to the GP is advisable.
Q. Nightscentedgarden: My 11-year-old son suffers badly during descent when flying. We have seen a doctor who says there is no problem but six years ago another doctor said he had a perforated eardrum. Do these repair themselves? What else could be causing the problem? We have, of course, tried all the suggested remedies for the pain on the plane.
A. Karen Finch: Yes, the eardrum can repair itself and I would like to think that when the GP took a look that he/she would have seen if the perforation was still open or had completely healed.
When flying many children and adults experience discomfort upon descent. To explain further, under normal circumstances, the human Eustachian tube is closed, but it can open to let a small amount of air through to prevent damage by equalising pressure between the middle ear and the atmosphere. Pressure differences can cause temporary conductive hearing loss by decreased motion of the eardrum and ossicles of the ear.
Various methods of ear clearing such as yawning, swallowing, or chewing gum may be used intentionally to open the tube and equalise pressures. When this happens, we hear a small popping sound, an event familiar to aircraft passengers, scuba divers, or drivers in mountainous regions.
Q. Kveta: My son, age three, is now under consultant care for his recurrent ear infections. Getting the referral from the GP was like drawing teeth. The ENT consultant took one look and got him on low-dose Trimethoprim for six weeks, which seems to have done the trick. Why are GPs so reluctant to treat ear infections?
A. Karen Finch: In the main, many earaches and infections naturally sort themselves out. GPs have been criticised for dishing out antibiotics like sweeties in the past and they prescribe using evidence-based practice wherever possible. Once an ENT consultant is involved, this clinician who specialises in all things ears will prescribe as necessary.
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